Provider First Line Business Practice Location Address:
210 B SMITH CHURCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROAONKE RAPIDS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27870-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-535-8870
Provider Business Practice Location Address Fax Number:
252-535-8868
Provider Enumeration Date:
05/17/2007